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Is the use of endoloops safe and efficient for the closure of the appendicular stump in complicated and uncomplicated acute appendicitis?

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Abstract

Introduction

There is still controversy regarding the ideal technique to close the appendicular stump in laparoscopic appendectomy (LA). The objective of this study was to determine the safety and efficiency of the use of an endoloop (EL) and endostapler (ES) in complicated and uncomplicated acute appendicitis.

Methods

Retrospective cohort study of patients undergoing LA from February 2013 to December 2019. Acute uncomplicated and complicated appendicitis were analysed separately, establishing two groups according to the stump closure technique: EL or ES. Seven hundred-nine patients were included (535 uncomplicated and 174 complicated). In uncomplicated appendicitis, an EL was used in 447 of the patients (83.55%) and an ES was used in 88 patients (16.45%). In complicated appendicitis, an EL was used in 85 patients (48.85%) and an ES was used in 89 patients (51.15%). An analysis of effectiveness and a cost analysis of each technique were performed.

Results

In uncomplicated appendicitis, we found no differences with respect to global complications, although there were significant differences in the total mean hospital stay (EL group 1.55 (SD 1.48) days; ES group 2.21 (SD 1.69) days; p = 0.046). This meant a savings of 514.12€ per patient using the EL p < 0.001). In complicated appendicitis, the reoperations classified as Clavien-Dindo IIIB in the EL group (6.4%) were greater than in the ES group (0%) (p = 0.012), although the rate of postoperative abscesses (p = 0.788) and the mean volume of abscesses (p = 0.891) were similar.

Conclusion

The systematic use of an EL could reduce costs in uncomplicated appendicitis, while in complicated cases, both options are valid. Prospective studies with a greater number of patients are needed to observe differences in postoperative complications.

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Authors and Affiliations

  1. Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain

    Virginia Durán Muñoz-Cruzado, Gregorio Anguiano-Diaz, Luis Tallón Aguilar, José Tinoco González, Alejandro Sánchez Arteaga, Daniel Aparicio Sánchez, Felipe Pareja Ciuró & Javier Padillo Ruiz

Authors
  1. Virginia Durán Muñoz-Cruzado
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  2. Gregorio Anguiano-Diaz
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  3. Luis Tallón Aguilar
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  4. José Tinoco González
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  5. Alejandro Sánchez Arteaga
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  6. Daniel Aparicio Sánchez
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  7. Felipe Pareja Ciuró
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  8. Javier Padillo Ruiz
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Contributions

Study conception and design: Felipe Pareja Ciuró and Virginia Durán Muñoz-Cruzado. Acquisition of data: Gregorio Anguiano Díaz and Daniel Aparicio Sánchez. Analysis and interpretation of data: Alejandro Sánchez Arteaga and José Tinoco González. Drafting of manuscript: Gregorio Anguiano Díaz and Virginia Durán Muñoz-Cruzado. Critical revisión of manuscript: Luis Tallón Aguilar, Felipe Pareja Ciuró and Javier Padillo Ruiz.

Corresponding author

Correspondence to Felipe Pareja Ciuró.

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The authors declare that they have no conflict of interest.

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Approval for this prospective review was obtained from Hospital Universitario Virgen del Rocío. The procedures in this study adhere to the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Durán Muñoz-Cruzado, V., Anguiano-Diaz, G., Tallón Aguilar, L. et al. Is the use of endoloops safe and efficient for the closure of the appendicular stump in complicated and uncomplicated acute appendicitis?. Langenbecks Arch Surg 406, 1581–1589 (2021). https://doi.org/10.1007/s00423-020-02050-3

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  • DOI: https://doi.org/10.1007/s00423-020-02050-3

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